Text by Henrylito D. Tacio
(First of Two Parts)
With an infected toe, Rommel Barro went to see a doctor in one of the largest hospitals in Davao City. When the doctor told him that his foot had to be amputated, he was totally unprepared for what he heard. He went home and refused to see any other healthcare providers.
As expected, the wound got so bad that even neighbors could already smell the foul odor. They complained to their barangay captain, who approached Dr. Isagani Braganza for help.
Dr. Braganza is a physician who is involved in an innovative project initiated by Handicap International, which is implemented in collaboration with local health authorities and supported by the World Diabetes Foundation (whose story of Rommel was featured on its website).
Rommel has no other choice but to see Dr. Braganza. When he came to the consulting room at the Jacinto Health Center, the doctor welcomed him. After removing his tennis shoe and sock, the doctor saw a swollen ankle and a foot with a missing second toe.
All over the world, diabetes is fast becoming a threat to public health. In the Philippines, diabetes is the eighth leading cause of mortality, according to a handout circulated by The Diabetes Store. About 500 Filipinos are added to the demographic daily.
Unknowingly, diabetes has exceeded projected rates worldwide. In 2000, the International Diabetes Federation estimated about 320 million diabetics globally by 2025. But even before that forecasted year, there were already 415 million diabetics in 2015.
Considered before as a “disease of affluence,” diabetes is now taking its place as one of the main threats to human health in the 21st century. “Diabetes is going to be the biggest epidemic in human history,” warns Dr. Paul Zimmet, director of the International Diabetes Institute in Victoria, Australia.
The Philippine Center for Diabetes Education Foundation, Inc. – also known as Diabetes Center – discloses that 50% of those suffering from diabetes do not know they have the disease.
As a result, “many patients die because it is already too late to remedy the situation,” to quote the words of Dr. Ricardo Fernando, director of the Institute for Studies and Diabetes Foundation in the Philippines.
This is particularly true among children. “A doctor cannot tell that a child is diabetic until he or she starts to complain and usually that is already late as far as complications are concerned,” said Dr. Fernando.
But what alarm experts is that Filipinos diagnosed with diabetes are getting younger. “Children as young as 5-years old have been diagnosed with diabetes,” reports the Diabetes Philippines (formerly Philippine Diabetes Association).
Long before Greeks found a word for it, diabetes (passing) was already a plague in Egypt. In the world’s oldest known medical document, dated 1500 B.C., Egyptian physicians referred to the symptoms. The word “mellitus” (honey) was added later by the Greeks, making the descriptive phrase diabetes mellitus – passing sweet – to describe the sweet urine passed by diabetes.
By the 19th century, scientists had learned that the mysterious disease that causes sweetness (which they then knew to be sugar) in the urine was somehow due to an abnormality of the pancreas.
Diabetes, as defined by the Merck Manual of Medical Information, is “a disorder in which blood sugar (glucose) levels are abnormally high because the body does not produce enough insulin.”
But before probing deeper, let’s first discuss this hormone released from the pancreas called insulin. “Insulin controls the amount of sugar in the blood,” the Merck manual notes. “When a person eats or drinks, food is broken down into materials, including sugar, that the body needs to function.
“Sugar is absorbed into the bloodstream and stimulates the pancreas to produce insulin. Insulin allows sugar to move from the blood into the cells. Once inside the cells, sugar is converted to energy, which is either used immediately or stored until it is needed.”
The levels of sugar in our blood vary normally throughout the day. “They rise after a meal and return to normal within about 2 hours after eating,” the Merck manual informs. “Once the levels of sugar in the blood return to normal, insulin production decreases.”
“But with diabetes, something goes awry,” says Dr. Willie T. Ong, an internist-cardiologist who serves as a consultant in cardiology at Makati Medical Center. “The pancreas becomes irresponsible. It either stops producing the hormone completely or else produces too much, which leads to insulin resistance. Either way, the concentration of sugar in the blood shoots sky-high.”
Of course, the body tries to eliminate sugar. “The best to do that is via the urine,” says Dr. Isadore Rosenfeld, author of The Best Treatment. “But since the kidneys can’t excrete sugar in lump form, the body must provide enough water to dilute or dissolve the sugar in order to flush it out.”
The net result of all this is that the person will spend more and more time in the bathroom to avoid the sugar and at the water tap to drink the much-needed extra water. This is the basis why the cardinal signs of untreated diabetes are frequent urination and great thirst. In women, the urine rich in sugar provides a good medium for fungus to grow in the vagina, hence the vaginal itching.
Actually, there are two types of diabetes. Type 1 (formerly called insulin-dependent diabetes or juvenile-onset diabetes) occurs in only 10-15% of all cases and tends to occur in people under the age of 30. Onset is normally sudden and dramatic. More than 90% of the insulin-producing cells of the pancreas are permanently destroyed. The exact cause is unknown, but it’s generally thought to be inherited.
Environmental factors may also be a trigger. “Scientists believe that an environmental factor — possibly a viral infection or a nutritional factor in childhood or early adulthood — causes the immune system to destroy the insulin-producing cells of the pancreas,” the Merck manual notes.
As insulin-producing cells in the pancreas are damaged, insulin must be injected to keep the patient alive. “Aside from being safe, (insulin treatment) is cost effective compared with taking several classes of anti-diabetes pills at the same time,” points out Dr. Linda Lim-Varona, an internal medicine specialist.
Singer and actor Gary Valenciano also have this type of diabetes. His wife, Angeli, has saved the life of her husband several times already. “She has revived me a number of times, preventing me from falling into a diabetic coma,” he reveals.
Type 2 (called non-insulin-dependent diabetes or adult-onset diabetes previously) is the most common form; it accounts for about 90% of all cases. In this type, the pancreas continues to produce insulin, sometimes even at higher-than-normal levels. But the body develops resistance to the effects of insulin, so there is not enough insulin to meet the body’s needs.
It is considered a “lifestyle-related condition” as it is caused by excessive weight, physical inactivity, and stress. “If you look at the spread of the scourge around the world, Type 2 diabetes occurs as a country advances technologically, when people come out of the fields to sit behind desks,” notes Dr. Irwin Brodsky, director of the Diabetes Treatment Program at the University of Illinois in Chicago.
There might also be a genetic link; it often runs in families. Certain diseases and drugs (like corticosteroids) can also affect the way the body uses insulin and can lead to developing this type of diabetes.
Type 2 diabetes may also “occur in people with excess production of growth hormone and in people with certain hormone-secreting tumors,” the Merck manual says. “Severe or recurrent pancreatitis and other diseases that directly damage the pancreas can lead to diabetes.”
Usually, Type 2 diabetes occurs in people over 40, but it is now becoming more prevalent in children and teenagers. Studies have shown that most children diagnosed of having diabetes eat too much high-calorie junk food. “Across the globe, more people are consuming high-fat foods that are heavily processed and low in fiber,” the International Diabetes Foundation notes. “Increasingly, families are eating food prepared outside the home.”
The majority of children (some 85%) with Type 2 diabetes are overweight or obese at the time of diagnosis. The figure is quite alarming as only three percent of children were considered obese back in 1998, according to Dr. Yolanda Olivares of the Department of Health. Five years later, the figure rose alarmingly as 2.6% of children under five years were found overweight while five percent of children from six to 12 years old were found overweight. This means that these obese children are at increased risk of diabetes. (To be concluded)